Volume 1, Issue 2,
January 2000

Sporting events and elite athletes have captured the imagination of the public and the media. This is reflected by television coverage, and newspaper and magazine articles devoted to all aspects of sport. Thus, they will not pass up any opportunity to get an exclusive interview or information about a sports personality.

Over the last two decades participation in sporting events including long distance running events, cycle races, triathlons, rugby, and soccer matches at all levels, has increased dramatically. From a medical perspective, increased participation at such sporting events can be viewed as a potential major casualty situation.

In this article, emphasis will be placed on URTI, the most common type of infection reported by athletes around the time of competition. The chronic and acute immune response to heavy exertion will be briefly reviewed, with guidelines provided for the prevention and management of URTI in athletes.

This article outlines the medical challenges to provide the best medical care to athletes, spectators, and staff at the Sydney 2000 Olympic and Paralympic Games. It emphasizes the enormous organization that this has involved to cover all aspects of medical care for the duration of the Games.

Key concepts on heat dissipation in the exercising athlete and effective strategies on heat acclimatization and fluid replacement are briefly reviewed. Heat acclimatization refers to the adaptive process that occurs when a person moves from a cool to a hot environment; most of the physiological adjustments take place within the first 10 to 14 days. Hydration status can be followed by monitoring daily body weight, fluid intake, urine output, and urine color. For most sports activities, drinking about 1 liter per hour of a 6% carbohydrate-electrolyte sports beverage can provide adequate fluid and energy substrate to sustain exercise performance. This guideline should be individualized based on body size, sweat rate, and type and intensity of exercise. The importance of education in the prevention of heat illness among athletes and spectators is discussed.

Travel fatigue is associated with long haul flights, and jet lag is experienced when flights entail transmeridian travel. Symptoms are linked with disturbance of the body's circadian rhythms. Exercise performance may be affected until the body clock is adjusted to the new time zone. Methods of speeding up the adjustment include pharmacological and behavioral methods. Emphasis is placed on behavioral strategies and appropriate use of exposure to light. Care is needed in the timing of exercise training, particularly having traveled eastwards. A holistic strategy incorporates planning for the journey, for the flight itself, and for the days immediately following.

Environmental factors including air pollutants and levels of aero-allergens such as pollens may adversely affect atopic athletes during training and competition for premier sporting events where any impairment of performance may cost an athlete a hard won victory. The Sydney Olympic Games will be held in the spring, at the height of the pollen season, so team doctors must be aware of this and plan particular strategies for potentially affected competitors. Adequate preparation includes a careful assessment for the presence of allergic disease and exercise-induced asthma, followed by the provision of appropriate, permitted medication.

Many elite athletes believe that training at altitude improves sea level performance. Yet the scientific evidence, such as it is, would seem to refute this, suggesting that the athlete's trust may be misplaced. However, these scientific studies do not exclude the possibility that altitude training might produce an effect (<1%) that is too small to be detected by current research methods, but which might be of very real significance to the elite athlete for whom a much smaller effect would be sufficient to ensure an Olympic medal or a new world record. In contrast, living at altitude and training at or near sea level - the process known as "living hi and training low" - may produce larger, more easily measurable effects (<1.25%) in individual athletes. It is speculated that this benefit occurs only in those athletes (i) who mount an appropriate increase in renal erythropoeitin (EPO) production with an increase in red blood cell (RBC) mass and (ii) who are able to sustain a high training intensity (running velocity) when training at low altitude. Hence, this effect requires that athletes live at altitudes of at least 2,500 m and perhaps up to 4,000 m, and have adequate iron stores to sustain increased RBC production occasioned by the altitude-induced increase in EPO production. They need also to train at an altitude sufficiently low that they are able to train at velocities equivalent to those achieved during sea level competition. Hence, at present, elite athletes can be neither encouraged to, nor discouraged from, training at altitude. Individual experience, rigorously evaluated, is the sole method by which correct conclusions can be drawn for individual athletes. Even a 1% improvement in performance will not make a sub-elite athlete elite; hence, there is no reason to encourage sub-elite athletes to train at altitude.